Antiseptic mouthwashes could worsen xerostomia in patients taking polypharmacy.

OBJECTIVE: Polypharmacy is a common cause of xerostomia. This study aimed to investigate whether xerostomia could be an adverse drug event of mouthwashes, when they are used for longer than 2 weeks by patients taking polypharmacy. MATERIALS AND METHODS: This cross-sectional observational study included 120 hospitalized patients (60 middle-aged and 60 elderly patients), taking polypharmacy (≥4 drugs daily) and at risk of drug-induced xerostomia. Xerostomia was assessed by questioning participants. RESULTS: A total of 62.5% of patients complained of xerostomia. In the middle-aged group (mean age=44.0 (8.7) years; 35.0% women) xerostomia seemed independently associated to mouthwashes, at the limit of significance (OR=5.00, 95% CI=0.99-25.3, p=0.052). Active principles in mouthwashes were mainly quaternary ammonium compounds (91.9%). Mouthwashes may disturb the healthy balance of the biofilm moisturizing the oral mucosa. The biofilm contains mucins, salivary glycoproteins with oligosaccharides side chains able to sequester water and endogenous bacteria surrounded by a glycocalyx. Oral bacteria are fully susceptible to quaternary ammonium (chlorhexidine, hexetidine, cetylpyridinium chloride) and to other antiseptics used in mouthwashes, such as betain, resorcin, triclosan, essential oils and alcohol. However, caregivers currently recommend such dental plaque control products to patients suffering from xerostomia in order to reduce the risk of caries and periodontitis. CONCLUSION: This study is the first report that use of antiseptic mouthwashes for more than 2 weeks could worsen xerostomia in patients taking polypharmacy. Oral care protocols should avoid this iatrogenic practice, particularly when xerostomia alters the quality-of-life and worsens malnutrition.

Modified Tunnel Technique Combined with Enamel Matrix Derivative: A Minimally Invasive Treatment for Single or Multiple Class I Recession Defects.

PURPOSE: Gingival recession is a significant problem in the esthetic zone. Connective tissue grafts have been considered the gold standard, but they need a donor site that increases morbidity and discomfort for the patient.The purpose of the present study was to evaluate the clinical results of a modified tunnel technique that consists of replacing the connective tissue graft by enamel matrix derivative, in the treatment of Miller Class I recession defects. MATERIALS AND METHODS: Twenty-six teeth in 14 subjects with Miller Class I recessions were treated using the tunnel procedure plus enamel matrix derivative. The gingival recession, probing depth, clinical attachment level, and the width of the keratinized gingival tissue were recorded. RESULTS: There was a statistically significant reduction in gingival recession (88% of root coverage) and a gain in clinical attachment level (3.1 mm) between baseline and 24 months post-operatively, whereas the change in width of keratinized tissue and in probing depth was not statistically significant. All patients were satisfied with the esthetic appearance and would undergo the same surgery again. CONCLUSION: This technique could be successfully used as an alternative to connective tissue grafts, with the advantage of avoiding the discomfort and morbidity of connective tissue harvesting. CLINICAL SIGNIFICANCE: This modified tunnel technique using enamel matrix derivative potentially represents a clinically and esthetically satisfactory treatment of Miller Class I recession defects.

In Vitro Screening of the Antibacterial and Anti-Candida Properties of Crushed Nonantimicrobial Drugs Frequently Prescribed in Nursing Homes.

Frail older adults often experience swallowing disorders, prompting nursing staff to crush tablets, open capsules, and mix drugs into their meals or gelled water. However, crushing drugs can lead to pharmacological and gustatory problems. As crushed drugs can stay in prolonged contact with oral microbial biofilm, the current study aimed to investigate their antimicrobial properties. Crushed drugs were diluted in 1 mL of isotonic water and assayed in vitro for: (a) growth inhibition of five bacterial strains and Candida albicans by the diffusion method; (b) inhibition of Streptococcus salivarius and C. albicans biofilm formation; and (c) elimination of a preformed biofilm of S. salivarius and C. albicans after 5-minute contact. Eight of 29 crushed drugs inhibited bacterial and/or fungal growth on agar plates. Twenty-eight of 29 crushed drugs reduced the total biomass when incubated with S. salivarius, and 28 of 29 crushed drugs inhibited C. albicans biofilm formation. Preformed biomass was reduced by ≥25% by seven of 29 drugs. Crushed drugs may unbalance oral ecosystems and contribute to oral inflammation. [Res Gerontol Nurs. 2018; 11(2):82-90.].